基于扩散加权成像的MRI多种模型对高、低级别肾透明细胞癌的诊断价值  

Diagnostic Value of Multiple MRI Models Based on Diffusion-Weighted Imagingfor High and Low Grade Clear Cell Renal Cell Carcinoma

作　　者：徐景景[1] 秦元林 王唯伟 胡喜斌[1] 陈月芹[1] 朱来敏[1] XU Jingjing;QIN Yuanlin;WANG Weiwei(Department of Medical Imaging,Affiliated Hospital of Jining Medical University,Jining,Shandong Province 272029,P.R.China)

机构地区：[1]济宁医学院附属医院医学影像科,272029

出　　处：《临床放射学杂志》2024年第12期2108-2113,共6页Journal of Clinical Radiology

基　　金：济宁市重点研发计划项目(编号:2022YXNS061);山东省自然科学基金面上项目(编号:ZR2021MH109)。

摘　　要：目的 探讨基于扩散加权成像的MRI多种模型对高、低级别肾透明细胞癌(CCRCC)的诊断价值。方法回顾性分析经病理证实的CCRCC患者66例,低级别组49例,高级别组17例。所有病例均行扩散加权成像、体素内不相干运动成像(IVIM)及扩散峰度成像(DKI)检查。分析两组间的临床病理资料、常规MRI征象、表观扩散系数(ADC)及IVIM、DKI参数,其中IVIM参数包含真实扩散系数(D)、灌注相关扩散系数(D^(*))、灌注分数(f),DKI参数涵盖平均扩散峰度值(MK)、平均扩散率(MD);绘制ROC曲线比较其诊断效能。结果 高级别组CCRCC较低级别组病变边界多不清晰,更容易出血,且脂肪浸润、静脉癌栓及淋巴结肿大相对更多见,两组差异有统计学意义(P<0.05)。将边界、出血、肾周脂肪浸润、静脉瘤栓、淋巴结转移联合的常规MRI模型的AUC为0.816,敏感度为100%,特异度为52.94%,准确度为87.9%。高级别组CCRCC的ADC、D、MD低于低级别组,而MK高于低级别组(P<0.05),D^(*)和f差异无统计学意义。单一参数中D值的诊断效能(AUC=0.852)最大、特异度(94.12%)最高。联合ADC、D、MD、MK多种参数值,其诊断效能(AUC=0.926)明显高于单一参数(Z=3.226,P=0.0013;Z=2.217,P=0.0267;Z=2.512,P=0.0120;Z=2.605,P=0.0092),其特异度(100%)、准确度(84.8%)高于常规MRI模型,最佳诊断阈值为ADC=1.55×10^(-3)mm^(2)/s、D=0.60×10^(-3)mm^(2)/s、MD=1.36×10^(-3)mm^(2)/s, MK=1.53。结论 基于扩散加权成像的MRI多种模型可应用于对CCRCC高、低级别的预测,联合DWI、IVIM、DKI模型可提升对高、低级别CCRCC的鉴别诊断效能,有利于患者术前精准评估、治疗。Objective To investigate the diagnostic value of multiple MRI models based on diffusion-weighted imaging(DWI)for high and low grade clear cell renal cell carcinoma(CCRCC).Methods A retrospective analysis of 66 cases of histopathologically confirmed CCRCC patients was conducted.There were 49 cases in the low grade group and 17 cases in the high grade group.All cases were examined with diffusion weighted imaging(DWI),intravoxel incoherent motion imaging(IVIM),and diffusion kurtosis imaging(DKI).Clinical pathological data,conventional MRI features,and apparent diffusion coefficient(ADC),IVIM and DKI parameters between the two groups were analyzed.The IVIM parameter includes true diffusion coefficient(D),perfusion-related diffusion coefficient(D^(*)),perfusion fraction(f),and the DKI parameter includes mean diffusion kurtosis(MK),mean diffusivity(MD).ROC was plotted to compare the diagnostic efficacy.Results Compared with the low grade CCRCC group,unclear lesion boundary,bleeding,fat infiltration,venous tumor thrombus and lymph node metastasis were more common in the high grade CCRCC group,,and the difference between the two groups was statistically significant(P<0.05).The AUC of conventional MRI model including border,hemorrhage,perirenal fat infiltration,venous tumor thrombus and lymph node enlargement was 0.816,the sensitivity was 100%,the specificity was 52.94%,and the accuracy was 87.9%.ADC,D and MD of CCRCC in high-grade group were lower than those in low-grade group,while MK was higher than those in low-grade group,with statistical significance(P<0.05),and there was no statistical difference in D^(*)and f.The D value of a single parameter had the largest diagnostic efficacy(AUC=0.852)and the highest specificity(94.12%).The diagnostic efficiency(AUC=0.926)of ADC,D,MD,and MK combined with multiple parameter values was higher than that of single parameter(Z=3.226,P=0.0013;Z=2.217,P=0.0267;Z=2.512,P=0.0120;Z=2.605,P=0.0092).The specificity was 100%and the accuracy was 84.8%,which were higher than that of conventio

关 键 词：肾透明细胞癌 扩散加权成像 体素内不相干运动 扩散峰度成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R737.11[医药卫生—诊断学]